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수술에 의한 요관 손상시 경피적 신루설치술과 체내 요관 스텐트 설치술의 유용성

Postoperative Ureteral Injury Treated by Percutaneous Nephrostomy and Ureteral Stent

Abstract

Purpose : To evaluate percutaneous nephrostomy and ureteral stent placement in patients with postoperativeureteral injury. Materials and Methods : Percutaneous nephrostomy and antegrade ureteral stent placement wereattempted in 12 patients with postoperative ureteral injuries. The previous operations which caused ureteralinjuries included ureteroscopic extraction of ureteral stones(7), total abdominal hysterectomy due to uterinemyoma(2), ureteroscopic biopsy in a patient with ureteral tuberculosis(1), open ureteroplasty due toretroperitoneal fibrosis(1), and ureterocystostomy during renal transplantation(1). After percutaneousnephrostomy, a 7.0 F ureteral stent was inserted in each patient. The stent was removed under cystoscopic guidancefour to six weeks after this procedure. Urinalysis was performed to evaluate the presence of urinary tractinfection after ureteral stent placement. Ultrasonography and/or intravenous urography were performed three weeksafter stent placement, and every six months after the stent removal. Results : Percutaneous nephrostomy andplacement of an antegrade ureteral stent were successfully performed in all 12 patients. In three patients, thediagnosis of ureteral injuries was made immediately and in nine was delayed for between two and nineteen days. Theureteral stents remained in position for 25-95 days (average, 51) ; no evidence of urine leakage or ureteralstricture was seen on the follow-up examinations carried out from six months to several years after removal of thestent and no case required reintervention. Conclusion : Percutaneous nephrostomy and antegrade ureteral stentingare easy to perform, provide for the drainage of urine, cause no significant complication and show a successfultherapeutic effect, and are this effective non-operative interventional techniques for patients with postoperativeureteral injury.

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참고문헌 (16)

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